DHHS must pay for Medicaid claims system failure

DHHS must pay for Medicaid claims system failure

Elizabeth McMichael

Seven medical practices in North Carolina filed a lawsuit Jan. 16 against the North Carolina Department of Health and Human Services, Computer Sciences Corp., SLI Global Solutions and Maximus Consulting Services for failures in the new Medicaid system in the state.

Computer Sciences Corp. built and is operating the system called N.C. Tracks,  SLI Global Solutions, was hired to test the software and Maximus Consulting Services provided independent reviews. The lawsuit claims that errors with the new system caused damages to Medicaid providers.

N.C. Tracks, which replaced the old Medicaid claim processing system in July 2013, was supposed to process Medicaid claims more efficiently.

I cannot help but agree with the claims of incompetence set forth by the lawsuit. While it outperformed the previous 35-year-old system it replaced, it shows many major flaws that have become a hindrance to the practices and patients that depend on Medicaid benefits to receive care.

The Medicaid program covers nearly 1.7 million people in the state of North Carolina, all of whom were supposed to be benefited by this new system. But the system has been having problems since it came online last summer, according to the lawsuit. Doctors have said that claims are being wrongfully rejected and payments have been denied or the wrong amount has been paid.

The lawsuit goes on to further state that the original project completed by the CSC took more than a decade to complete and was $200 million over budget. This does not pose a good defense for the DHHS.

Audits done on the system have been extremely critical, which only further supports the lawsuit, according to the state’s audit office. This shows obvious incompetence, and someone needs to be held accountable.

Reports that were filed in December show that the system had more than 3,200 defects since it’s start in July, and more than 600 defects had not been fixed by November, according to the News & Observer.

The DHHS has stated that this lawsuit is unfounded and that the system is functioning far better than the previous system, having processed 104 million claims and providing $5.5 billion in Medicaid payments to North Carolina health care providers. They claimed that it would work to fix defects in the system.

But many medicals practices reported that they still have not received payment for claims that were incorrectly denied. Still others claim that processing errors continue to come despite the DHHS claiming otherwise.

For N.C. Tracks to operate properly, the claims system has to be updated to the point where claims will not be wrongfully rejected, and the correct amounts of money are given back to the medical practices that depend on Medicaid payments.

This system must also be properly tested by an impartial third party, proving that there are fewer errors that will prohibit or delay payments.

Opinion: Elizabeth McMichael, Opinion Writer